Provider Demographics
NPI:1255675856
Name:GABRIEL, MELODY (DPT)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13900 MARQUESAS WAY APT 5117
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6064
Mailing Address - Country:US
Mailing Address - Phone:310-853-3448
Mailing Address - Fax:855-252-5571
Practice Address - Street 1:8540 S SEPULVEDA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045
Practice Address - Country:US
Practice Address - Phone:310-853-3448
Practice Address - Fax:310-252-5571
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGU815ZMedicare PIN